Wilderness First Aid

In a recent issue of Wilderness and Environmental Medicine (Volume 20, Number 2, 2009), Thomas Welch and colleagues have written an article entitled “Wilderness First Aid: Is There an Industry Standard?” The purpose of their inquiry was to determine if an “industry standard” exists for wilderness first aid training and certification of outdoor adventure and education leaders. To attempt to answer the question, they queried regulatory authorities, national organizations, and school/college groups with regard to their requirements for first aid training of their wilderness trek leaders.

They discovered that 10 or the 22 states with guide licensure programs required any first aid training as a condition of licensure, and none specified a specific course. Of the programs requiring such training, the requirements ranged from a 6-hour standard first aid course to more structured “wilderness first responder” (WFR, or “woofer”) certification.

The authors concluded that there exists no uniform industry standard for first aid training and certification of wilderness leaders. They further commented that the epidemiology of backcountry injuries as well as what is currently known about clinical skills retention indicate that there may be little evidence basis for much of current practice with regard to wilderness first aid training.

What can we take away from this? First, there are not great data collections to determine the true incidence of specific injuries and illnesses that occur in the outdoors. We are familiar with the serious afflictions, such as drowning, falls, and frostbite, that can occur, but everyone’s general impression is that most medical events are minor. The implication of this is not clear for training, because we train for all eventualities, including the worst ones., even though they may not be common.

We also know that it is difficult to retain skills, particularly those that are complicated, without repetition and frequent reminders. Such is the case in medicine as much as it is in music, math, and athletics. There are good studies to show how quickly medical skills, such as cardiopulmonary resuscitation (CPR) deteriorate if they are not refreshed and practiced regularly. So, what should be taught to guides, instructions, and trip leaders who are responsible for the care of their participants in the outdoors? The best we can advise right now is that basic first aid with augmentation about wilderness-specific concerns seems reasonable, and that knowledge and manuals skills should be tested at sensible intervals. There is definitely a role of guidebooks, in written or electronic format, so that one can obtain guidance in a prompt fashion. There is no substitute for skill, but that is only acquired through years of experience, enhanced by repetition, resourcefulness, and sometimes bravery.